Using a Learning System Approach to Improve Safety for Prone-Position Ventilation Patients.

OBJECTIVES: This study aimed to describe how a Patient Safety Organization, to which healthcare organizations submit patient safety event data for both protections and analysis, used a learning system approach to analyze and interpret trends in member data. The data analysis informed evidence-based practice recommendations for improvement of patient outcomes for patients receiving prone-position ventilation. METHODS: Patient safety analysts with critical care nursing backgrounds identified a need for increased support of Patient Safety Organization members who were proning patients during the COVID-19 pandemic. Patient safety events from member organizations across the United States were analyzed and aggregated. Primary and secondary taxonomies for safety events experienced by patients receiving prone-position ventilation were created, which provided insight into harm trends in this patient population. RESULTS: Analysis of 392 patient safety events resulted in the identification of gaps in the care of these fragile patients, including but not limited to medical device-related pressure injuries, concerns with care delivery, staffing and acuity issues, and medical device dislodgement. Event themes in prone-position ventilation safety events informed a literature search from which an evidence-based action plan was developed and disseminated to Patient Safety Organization members for use in harm reduction efforts. CONCLUSIONS: Using a learning system approach, patient safety event data related to prone-position ventilation or any other type of patient safety event can be aggregated and analyzed to identify key areas of safety concerns and gaps in practice, allowing organizations to affect improvement efforts.

Pharmacological inhibition of TBK1/IKKε blunts COVID-19 immunopathology (preprint)

TANK-binding kinase 1 (TBK1) is a key signalling component that drives the production of type-I interferons (IFNs), which have essential antiviral activities including against SARS-CoV-2. TBK1 and its homolog IκB kinase-ε (IKKε) can also induce the production of pro-inflammatory factors that contribute to pathogen clearance. While initially protective, delayed engagement of type-I IFN is associated with lethal hyper-inflammation seen in severe COVID-19 patients. The contribution of TBK1/IKKε signalling to this response is unknown. We have discovered that the small molecule idronoxil inhibits both IRF3 and NF-κB-driven inflammation by disrupting the formation of TBK1/IKKε signalling complexes following STING activation. Leveraging this unique activity, we show that therapeutic administration of idronoxil suppresses cellular and molecular lung inflammation in K18-hACE2 mice challenged with SARS-CoV-2, resulting in reduced pro-inflammatory cytokine production and decreased airway fibrosis in experimental COVID-19. Our results indicate a critical role for TBK1/IKKε signalling in SARS-CoV-2 hyper-inflammation and identify a novel therapeutic intervention to limit disease severity in COVID-19 patients.

Five Questions for Residency Leadership in the Time of COVID-19: Reflections of Chief Medical Residents From an Internal Medicine Program.

The COVID-19 pandemic has drastically affected the traditional methods residency programs use to train their residents. Chief residents serve a unique role as part of the residency leadership to foster the education and development of the residents. Given the rapid shift in demands on physicians in the face of the pandemic, the responsibilities of the chief residents have also shifted to help prepare the residents to meet these demands as frontline providers. There is not a precedent for how residency programs respond to this crisis while maintaining their primary role to develop and train physicians. The authors have identified 5 questions chief residents can ask to guide their program's response to the demands of COVID-19 during this uncertain time in health care.